Effectiveness of predicting in-hospital mortality in critically ill children by assessing blood lactate levels at admission.
Effectiveness of predicting in-hospital mortality in critically ill children by assessing blood lactate levels at admission.
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DOI：
10.1186/1471-2431-14-83
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发表时间：
2014-03-28
期刊：
影响因子：
2.4
通讯作者：
Li Y
中科院分区：
文献类型：
--
作者：
Bai Z;Zhu X;Li M;Hua J;Li Y;Pan J;Wang J;Li Y
入院时的高乳酸血症是危重成人患者死亡的已知危险因素。然而，在一般危重儿童中，入院时单项乳酸测定对死亡率的预测意义仍不确定。这项研究评估了入院时血乳酸水平的预测价值，并确定了预测危重儿科人群住院死亡率的临界值。我们招募了1109名危重儿童，他们在2008年7月至2010年12月期间住进了儿科重症监护病房。入院后2小时内采集动脉血，测定血乳酸水平。在入院后24小时内计算儿科死亡风险III(PRISM III)评分。在入院的1109名儿童中，115名(10.4%)在医院死亡。危重患儿的中位数(四分位数范围)血乳酸水平为3.2 mm ol/L(2.2~4.8)。入院时血乳酸水平与死亡率显著相关(优势比[OR]=1.38；95%可信区间[CI]1.3-1.46；P<；0.001)，即使在调整了年龄、性别和PRISM III评估的疾病严重程度后(OR=1.27；P<；0.001)。多因素回归分析显示，高血乳酸水平(OR=1.17；95%CI，1.07~1.29；P=0.001)、高PRISM III评分(OR=1.15；95%CI，1.11~1.2；P<；0.001)、低血清白蛋白(OR=0.92；95%CI，0.88~0.96；P<；0.001)是危重患儿死亡的独立危险因素。血乳酸预测死亡率的受试者工作特征曲线下面积(AUC)为0.79(p<；0.001)，与PRISM III相似(AUC=0.82p<；0.001)。比较两种AUC的p值为0.318。血乳酸预测死亡率的敏感度和特异度分别为61%和86%，阳性似然比和阴性似然比分别为4.5和0.45。入院时的高血乳酸水平与危重儿童的一般人群的住院死亡率独立相关并可预测。
Hyperlactatemia upon admission is a documented risk factor for mortality in critically ill adult patients. However, the predictive significance of a single lactate measurement at admission for mortality in the general population of critically ill children remains uncertain. This study evaluated the predictive value of blood lactate levels at admission and determined the cut-off values for predicting in-hospital mortality in the critically ill pediatric population. We enrolled 1109 critically ill children who were admitted to a pediatric intensive care unit between July 2008 and December 2010. Arterial blood samples were collected in the first 2 hours after admission, and the lactate levels were determined. The Pediatric Risk of Mortality III (PRISM III) scores were calculated during the first 24 hours after admission. Of the 1109 children admitted, 115 (10.4%) died in the hospital. The median (interquartile range) blood lactate level in critically ill children was 3.2 mmol/l (2.2-4.8). Among the children, 859 (77.5%) had a lactate concentration >2.0 mmol/l. The blood lactate level upon admission was significantly associated with mortality (odds ratio [OR] = 1.38; 95% confidence interval [CI], 1.30-1.46; p <0.001), even after adjustment for age, gender, and illness severity assessed by PRISM III (OR = 1.27; p <0.001). Multivariate regression analysis showed that a high blood lactate level (OR = 1.17; 95% CI, 1.07-1.29; p = 0.001), a high PRISM III score (OR = 1.15; 95% CI, 1.11-1.20; p <0.001), and a low serum albumin (OR =0.92; 95% CI, 0.88-0.96; p <0.001) were independent risk factors for mortality in critically ill children. Blood lactate achieved an area under-the-receiver-operating-characteristic curve (AUC) of 0.79 (p <0.001) for predicting mortality that was similar to that of PRISM III (AUC = 0.82; p <0.001). The p-value for a comparison of both AUCs was 0.318. Blood lactate displayed a sensitivity of 61% and a specificity of 86% in predicting mortality at the optimal cut-off value of 5.55 mmol/l, and the positive and negative likelihood ratios were 4.5 and 0.45, respectively. A high blood lactate level at admission is independently associated with and predictive of in-hospital mortality in the general population of critically ill children.
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DOI：
10.1111/acem.12015
发表时间：
2012-11
期刊：
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
影响因子：
--
作者：
Green JP;Berger T;Garg N;Horeczko T;Suarez A;Radeos MS;Hagar Y;Panacek EA
通讯作者：
Panacek EA
DOI：
10.1186/1757-7241-19-74
发表时间：
2011-12-28
期刊：
Scandinavian journal of trauma, resuscitation and emergency medicine
影响因子：
--
作者：
Kruse O;Grunnet N;Barfod C
通讯作者：
Barfod C
影响因子：
--
作者：
Gustavsson, Lars;Andersson, Lars-Magnus;Westin, Johan
通讯作者：
Westin, Johan
影响因子：
3.3
作者：
Koliski, Adriana;Cat, Izrail;Cat, Mônica L.
通讯作者：
Cat, Mônica L.
影响因子：
6.8
作者：
Martin, Jan;Blobner, Manfred;Luppa, Peter B.
通讯作者：
Luppa, Peter B.